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Abnormally high risk of stroke in Brugada syndrome

Carlo de Asmundis1, Giacomo Mugnai1, Gian-Battista Chierchia1

  • 1Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|December 18, 2018
PubMed

Insights

Patients with Brugada syndrome (BrS) and atrial fibrillation face a high risk of cardioembolic stroke, often presenting as the first symptom. Standard risk scores like CHA2DS2Vasc are insufficient for predicting these events in BrS patients.

Area of Science:

  • Cardiology
  • Neurology
  • Genetics

Background:

  • Brugada syndrome (BrS) is an inherited cardiac arrhythmia.
  • Atrial fibrillation is a common comorbidity.
  • Cerebrovascular events pose a significant risk in BrS patients.

Purpose of the Study:

  • To evaluate the incidence of cerebrovascular events in BrS patients.
  • To identify predictors and clinical characteristics of cardioembolic events.
  • To assess the prognosis of these events in the context of atrial fibrillation.

Main Methods:

  • Retrospective analysis of 671 BrS patients over a mean follow-up of 10.8 years.
  • Diagnosis of ischemic stroke based on AHA/ASA guidelines using CT and angio-CT.
  • Evaluation of atrial fibrillation prevalence and clinical data.

Main Results:

  • 11.8% of BrS patients had atrial fibrillation.
  • The incidence of cardioembolic stroke in BrS patients with atrial fibrillation was 13.9%.
  • Stroke patients were often asymptomatic (91%) and older (59.4 years) with low CHA2DS2Vasc scores.

Conclusions:

  • Cardioembolic stroke incidence is unexpectedly high in BrS patients with atrial fibrillation.
  • Asymptomatic atrial fibrillation and older age are associated with stroke risk.
  • CHADS2 and CHA2DS2Vasc scores are inadequate predictors; more invasive diagnostics may improve AF detection.
Abstract

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